Diazepam or midazolam for orotracheal intubation in the ICU? / Diazepam ou midazolam para entubação orotraqueal na UTI?

Objective: to compare clinical and cost effectiveness of midazolam and diazepam for urgent intubation. Methods: patients admitted to the Central ICU of the Santa Casa Hospital Complex in Porto Alegre, over the age of 18 years, undergoing urgent intubation during 6 months were eligible. Patients were randomized in a single-blinded manner to either intravenous diazepam or midazolam. Diazepam was given as a 5 mg intravenous bolus followed by aliquots of 5 mg each minute. Midazolam was given as an intravenous bolus of 5 mg with further aliquots of 2.5 mg each minute. Ramsay sedation scale 5-6 was considered adequate sedation. We recorded time and required doses to reach adequate sedation and duration of sedation. Results: thirty four patients were randomized, but one patient in the diazepam group was excluded because data were lost. Both groups were similar in terms of illness severity and demographics. Time for adequate sedation was shorter (132 ± 87 sec vs. 224 ± 117 sec, p = 0.016) but duration of sedation was similar (86 ± 67 min vs. 88 ± 50 min, p = 0.936) for diazepam in comparison to midazolam. Total drug dose to reach adequate sedation after either drugs was similar (10.0 [10.0-12.5] mg vs. 15.0 [10.0-17.5] mg, p = 0.248). Arterial pressure and sedation intensity reduced similarly overtime with both drugs. Cost of sedation was lower for diazepam than for midazolam (1.4[1.4-1.8] vs. 13.9[9.4-16.2] reais, p <0.001). Conclusions: intubation using intravenous diazepam and midazolam is effective and well tolerated. Sedation with diazepam is associated to a quicker sedation time and to lower costs. .

Objetivo: comparar eficácia clínica e custo de midazolam e diazepam para intubação urgente. Métodos: pacientes internados na UTI Central do Complexo Hospitalar Santa Casa de Porto Alegre, >18 anos de idade e submetidos a entubação urgente durante seis meses eram elegíveis. Pacientes foram randomizados para receber diazepam ou midazolam intravenoso. Diazepam foi dado como bolus IV de 5 mg seguido por alíquotas de 5 mg a cada minuto. Midazolam foi dado como um bolus IV de 5 mg, com alíquotas adicionais de 2,5 mg a cada minuto. Escala de sedação de Ramsay 5-6 foi considerada sedação adequada. Registramos tempo e doses necessárias para atingir sedação adequada e sua duração. Resultados: trinta e quatro pacientes foram randomizados; um paciente no grupo diazepam foi excluído por perda dos dados. Grupos foram semelhantes para gravidade da doença e demografia. Tempo de sedação adequada foi mais curto (132 ± 87 vs. 224 ± 117 segundos, p = 0,016), mas a duração da sedação foi similar (86 ± 67 vs. 88 ± 50 min., p = 0,936) para o diazepam em comparação com o midazolam. Dose total da droga para atingir a sedação adequada foi semelhante para ambas as drogas (10,0 [10,0-12,5] vs. 15,0 [10,0-17,5] mg, p = 0,248). Pressão arterial e intensidade da sedação reduziram da mesma forma para ambas as drogas ao longo do tempo. O custo da sedação foi menor para diazepam do que para midazolam (1,4[1,4-1,8] vs. 13,9[9,4-16,2] reais, p < 0,001). Conclusões: entubação usando diazepam e midazolam intravenosos é eficaz e bem tolerada. Sedação com diazepam está associada a sedação mais rápida e menores custos. .

Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.

Background : Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases. Aims: To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine. Settings and Design : Outpatient gynecological department and open randomized trial. Materials and Methods : One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Statistical Analysis : Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the χ2 test. Results: Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13± 1.28; group II, 5.93± 1.26; group III, 5.58± 1.51), (P< 0.001); as well as 30 minutes later (group I, 1.78± 0.89; group II, 2.53± 0.81; group III, 2.23± 0.94), (P< 0.001) and 60 minutes later (group I, 1.2± 0.46; group II, 1.98± 0.83; group III, 1.68± 0.75), (P< 0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed. Conclusions : Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.

Comparative effects of diazepam infusion and divided doses of diazepam on the treatment of absence status epilepticus

Absence status epilepticus [ASE] is a common form of nonconvulsive status epilepcticus. It is characterized by loss of consciousness with spike and wave discharges in EEG simultaneously. The most effective treatment of ASE is diazepam, either infusion or in divided doses; the former is more expensive since patients must be admitted in an Intensive Care Unit. The aim of this study was to evaluate and compare the efficacy of diazepam infusion and parenteral diazepam in divided doses in the treatment of ASE. This randomized controlled clinical trial, enrolled 20 patients with absence status epilepticus. Diagnosis was made based on the clinical manifestations and electroencephalogram [EEG]. Prior to treatment, all patients underwent EEG and imaging. Patients were randomized to receive 0.2 mg/kg/h diazepam infusion or 0.2 mg/kg in six daily doses. Clinical and EEG improvements were considered to be optimal responses. Of the 20 patients studied, 13 [65%] were boys and the remaining 7[35%] were girls. There were no differences between the two groups regarding age and sex [non-significant]. Following treatments after 48 hours, 1 week and 1 month respectively, clinical improvement in previous problems [loss of consciousness, ataxia, behavior and speech problems] and EEGs was similar in both groups [p=1]. There were controlled seizures in 18 [90%], abnormal CT scans in 5 [25%], abnormal EEGs after treatments in 6 [30%] cases; however no significant differences were seen between the two groups. This study demonstrates that there are no significant differences between treatments of ASE with diazepam infusion and parenteral diazepam in divided doses. Treatment of ASE, with divided doses of diazepam is easier, less expensive and patients do not require to be hospitalized in an Intensive Care unit

[Comparing the effect of intermittent Diazepam and continuous Phenobarbital in prophylaxis of recurrence of febrile seizure]

The vast majority of children with febrile seizure have a normal long term out come, but their parents are always worrying about recurrent febrile seizure. With attention to controversy in treatment a precise knowledge of the short and long term side effect is an important prerequisite for assessing the various treatment strategies. In this study we evaluated the efficacy of intermittent Diazepam and continuous Phenobarbital for the prophylaxis of recurrence of febrile seizure. In this clinical trial study 100 children with febrile seizure treated with intermittent Diazepam were compared with 100 children with febrile seizure treated with continuous Phenobarbital. Diazepam [1 mg/kg/d] was administered orally every eight hours during all febrile illness and Phenobarbital [3-5 mg/kg/d] was administered daily. Data were analyzed by chi-square and t-test. During a mean follow up of 19 months, recurrence rates in the two groups were similar [14%]. 74% of children receiving Phenobarbital had side effects versus 26% receiving Diazepam. [p=0.00001]. Mean of fever in year was 3.2 +/- 1.4 in Phenobarbital group and 3.0 +/- 1.1 in which had no significant difference. Oral Diazepam, given only when fever is present, is safe and reduces the risk of recurrent febrile seizure

Intranasal midazolam versus intravenous diazepam for treating febrile seizures in children

This prospective randomized study was done in the emergency department at Al-Zahra Hospital [In Madinah] during a period of 12 months [from March 2003 to 2004] on 47 children aged 6 months to 5 years with prolonged febrile seizures [at least 10 minutes]. We aimed at comparing the efficacy and safety of midazolam given intranasal with diazepam given intravenously in the treatment of children with prolonged febrile seizures. The dose of midazolam was 0.2mg/kg intranasal, while the dose of diazepam was 0.3mg/kg intravenously. Overall 23 of 26 seizures were controlled with midazolam, and 24 of 26 with diazepam. The mean time from arrival at hospital to starting treatment was significantly shorter in the midazolam [3.5 [SD1.8] minutes, 95% confidence interval 3.3 to 3.7] than the diazepam group [3.5 [2.0], 5.3 to 5.7]. The mean time to control of seizures was significantly shorter [6.1 [3.6], 6.3 to 6.7] in the midazolam group than in the diazepam group [8 [0.5], 7.9 to 8.3]. No significant side effects were observed in either groups. We conclude that seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam, although midazolam was as safe and effective as diazepam. The overall time to cessation of seizures after arrival at hospital was faster with intranasal midazolam than with intravenous diazepam. The intranasal route can possibly be used not only in medical center, but also in general practice and, with appropriate instruction, families of children with recurrent febrile seizures at home

Premedication for coronary angiography: effects on anxiety and hemodynamic status.

AIM: This study was designed to compare the outcomes of two current methods of premedication, for coronary angiography with placebo, on the level of anxiety and hemodynamic status. METHODS AND RESULTS: In all, 151 patients referring for coronary angiography were randomized into three groups with equal populations. The first group (group M) received 0.02 mg/kg intravenous midazolam; the second (group DP7rpar; received intramuscular injection of 5mg diazepam + 25 mg promethazine; and the third (group P) received 2cc of intravenous normal saline solution. Vital signs, blood pressure, and peripheral O2 saturation were recorded in specifically-designed questionnaires. The level of anxiety before and after angiography was documented according to the Visual Analog Scale. Patients in the group M accidentally had higher pre-procedural anxiety level (p < 0.05). There was no significant difference in pulse rate, respiratory rate, and mean blood pressure (BP) between these groups prior to angiography. In the group M, diastolic BP decreased more significantly than the other 2 groups during angiography (p < 0.05). Although number of punctures, pain at catheterization site, dose of lidocaine, level of consciousness, and patient satisfaction did not show a significant difference between the three groups; midazolam induced higher level of amnesia than the other 2 groups and the physicians were more satisfied with it only compared with diazepam + promethazine (p < 0.05). CONCLUSION: Because of the importance of hemodynamic stability and comfort during angiography, non-pharmacologic approaches are preferred. In case of severity and persistence of autonomic system stimulation, the least effective dose of midazolam for a short period of time may be used.

Funny turns in an elderly man

A 74-year old man presented with recurrent attacks of altered sensorium, sometimes with abrupt falls, against the background of a long history of chronic obstructive airways disease and ischaemic heart disease. Investigations revealed evidence of significant cardiac conduction abnormalities and this led to the insertion of a permanent pacemaker. However, he continued to have recurrent 'syncopal'attacks. He was hospitalized to clarify the nature and aetiology of these attacks. Multiple stereotyped events were observed by different medical personnel, lasting up to two hours in duration. An attack was terminated by the administration of intravenous diazepam. Subsequent initiation of anti-epileptic drugs led to the complete abolition of these episodes. He has remained event-free since then ie two years. Because of multiple co-morbidities, the elderly present a greater diagnostic challenge in the evaluation of paroxysmal alterations in sensorium. It is essential that epilepsy, particularly with non-convulsive seizures, be included in the differential diagnosis whenever evaluating these patients.

Sedative effect of oral diazepam and chloral hydrate in the dental treatment of children.

PURPOSE: The purpose was to evaluate two sedation protocols during dental sessions in anxious children. MATERIALS AND METHODS: It was a randomized and double-blind study, with each individual being his/her own control within each protocol. Furthermore, the two protocols were compared. Twenty children (36 to 84 months old) who exhibited "definitely negative" behavior according to the Frankl scale were assigned to receive oral chloral hydrate (40 mg/kg) (Group I) or Diazepam (5 mg) (Group II). Behavior during local anesthesia, application of rubber dam, cavity preparation, restorative procedures was evaluated, considering the degree of sleep, body movement, crying and overall behavior. Vital signs were assessed at three different times. The Wilcoxon, Mann-Whitney, Exact Fisher's and Spearman correlation tests were used to analyze the data. RESULTS: Group I presented higher scores for sleep during the CH session than placebo session during rubber dam application (P = 0.0431) and restoration (P = 0.0431). In Group II there was no statistically significant difference (p > 0.05). There were no statistically significant differences between sessions and groups in the evaluation of body movement, crying and vital signs. Overall behavior in the placebo session was better than in the CH session during local anesthesia, but there was no difference between the two drug regimens. There was influence of age during anesthesia and cavity preparation in Group I and during rubber dam application in Group II. It was concluded that oral diazepam and chloral hydrate had no influence on the behavior management for dental treatment with the studied sample.

Efeitos sedativos e cardiovasculares do midazolam e do diazepam associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana / Medazolam and diazepam associated or not with clonidine cardiovascular and sedative effects on patients submitted to hemodynamic study in suspected of coronary arterial disease

Objetivo: Avaliar a qualidade da sedação e os efeitos sobre a frequência cardíaca e a pressão arterial do midazolam e do diazepam associados ou não a clonidina, em pacientes com suspeita de doença coronariana. Métodos - Foi desenvolvido ensaio clínico prospectivo, duplo cego, randomizado, controlado, com 160 pacientes. Estes apresentavam teste ergométrico ou cintilografia positivos para isquemia miocárdica e foram submetidos a cineangiocoronariografias diagnósticas eletivas, divididos em cinco grupos de 32 pacientes cada, de acordo com o fármaco utilizado: grupo : (clonidina 0,5 micrograma.kg-1); grupo M (midazolam 40 micrograma.kg-1); grupo MC associação do midazolam 40 micrograma.kg-1 e da clonidina 0,5 micrograma.kg-1); grupo D diazepam 40 micrograma.kg-1); grupo DC (associação do diazepam 40 micrograma.kg-1 e da clonidina 0,5 micrograma.kg-1). A sedação foi avaliada com base na escala de Ramsay e no consumo de meperidina (0,04 mg.kg-1) que foi utilizada nos pacientes que apresentaram agitação ou ansiedade durante o procedimento. A PA invasiva, a FC e o escore de sedação, foram analisados a cada 5 minutos em 4 diferentes momentos: M1 - início do exame; M2 - 5 minutos após o início do exame; M3 ­metade do tempo do exame e M4 - final do exame. Resultados - Os grupos foram homogêneos com relação à PA, FC e sedação 10 momento controle (M1). Os pacientes que utilizaram o midazolam apresentaram maiores escores de sedação e variação da FC e PA (p menor que 0,05). Os que utilizaram o diazepam ou a clonidina exibiram menores e mais apropriados escores de sedação para a realização do exame e apresentaram menor variação da PA e da FC (p maior que 0,05). A associação com a clonidina potencializou de forma mais precoce e acentuada os efeitos sedativos do midazolam em relação ao diazepam (p menor que 0,05). O consumo de meperidina não diferiu entre os grupos estudados (p maior que 0,10).

comparative study on the efficacy of rectal diazepam and midazolam for reduction of pre-operative anxiety in pediatric patients

Children, due to their great parental dependency, are amongst the cases that should receive preoperatively medication to reduce their fear and anxiety. The objective of this study was to compare the efficacy of rectal diazepam and midazolam for this purpose in pediatric patients scheduled for elective surgery. 60 children, aged between 1 and 6 years, scheduled for elective surgery, were included in this double blind, randomized controlled trial. Patients were randomly allocated into three equal groups. Patients in midazolam and diazepam groups received the drugs 0.3 mg/kg and 0.5 mg/kg respectively [in normal saline at a final volume of 2.5 ml] and placebo group received only 2.5 ml of normal saline 20 min before arriving operation room through rectal applicator. Sedation and anxiety scores at the time of separation from their parents before arriving operating room were recorded for all groups. There was a significant reduction in anxiety level in midazolam and diazepam groups as compared to placebo group [P<0.001]. Sedation rate was 65% for midazolam, 60% for diazepam, and 15% for placebo group [P=0.007]. There were no significant changes in hemodynamic parameters in the three study groups. With respect to effective anxiolytic and sedative activity, rectal midazolam [0.3 mg/Kg] and diazepam [0.5 mg/Kg] can be used as an anesthetic premedicant for children at pre-operative period and their use is safe regarding hemodynamic variables and related side-effects

Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures.

OBJECTIVE: To evaluate the safety and efficacy of intranasal midazolam for seizures and various procedures. METHODS: Prospective randomized study. Total 125 children of all ages of either sex, for seizure episode (n-76) and various invasive and non-invasive procedures (n-49) received either intranasal midazolam (0.2 mg/Kg) or intravenous diazepam (0.3 mg/Kg). RESULTS. Mean time from arrival at hospital to starting treatment was significantly shorter in midazolam group compared to diazepam group [2.34+/-0.90; minute vs 4.61+/-1.08 minute p< 0.001]. Mean time to control seizures after arrival in hospital was significantly shorter in midazolam group compared to diazepam group [5.25+/-0.86 minute vs 6.51+/-1.06 minute p. CONCLUSION: Midazolam by the intranasal route provides safe and equally effective non-invasive method of sedation for procedures and seizures.

Uso crônico de diazepam em idosos atendidos na rede pública em Tatuí-SP / Long-term use of diazepam in elderly patients treated by the public health system in Tatuí (SP, Brazil)

Propôs-se caracterizar o perfil de utilização do diazepam na população idosa (60 anos ou mais) usuária crônica, atendida no serviço de atenção primária de Tatuí-SP e estabelecer uma relação entre uso crônico, efeitos adversos, dependência e as recomendações preconizadas na literatura científica. Desenvolveu-se um estudo observacional, transversal, através de entrevistas semiestruturadas aplicadas em 70 idosos. Trata-se de uma amostra não probabilística, por tipicidade, de caráter voluntário. A amostra selecionada era composta por: 77,1% mulheres e 22,9% homens, sendo, 37,1% casados, 44,2% viúvos, 92,8% de baixa escolaridade, 94,2% aposentados e 91,4% portadores de doenças crônicas. O diagnóstico referido, que justificou a prescrição inicial em dose de 10mg/dia foi a ansiedade e a insônia (92,8%). Em 90% dos pacientes a orientação médica foi seguida, sem interrupção, por um tempo mediano de 60 meses com um mínimo de seis e máximo de 360 meses. Os possíveis efeitos adversos foram: tontura, dores articulares, angústia e depressão. Aqueles que tentaram não utilizar o medicamento (97,14%) relataram insônia, ansiedade e irritabilidade. Os dados deste estudo, sugerem que a dose padronizada pela rede pública de 10mg e o tempo de utilização não propicia uma prática consistente de elevação do bem estar desses usuários, visto que a maioria relatou efeitos adversos e síndrome de abstinência na ausência do medicamento; tornando-se conveniente uma cuidadosa monitorização clínica e uma orientação quanto à redução gradativa da dose.

Pharmacologic interventions for reducing spasticity in cerebral palsy.

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol.

Intramuscular midazolam vs intravenous diazepam for acute seizures.

OBJECTIVE: To determine effectiveness of intramuscular midazolam to control acute seizures in children as compared to intravenous diazepam. METHODS: 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study. Patients who already had an intravenous access present were treated intravenous diazepam. Patients without an i.v. access at the time of convulsions were randomised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures. Time interval from administration of drug to cessation of seizures was compared. Effectiveness of i.m. midazolam in various age groups, types of convulsions and etiology of convulsions was analyzed. Side effects of both drugs were evaluated. RESULTS: The mean interval to cessation of convulsions with i.m. midazolam was 97.22 seconds whereas in diazepam group without prior i.v. access it was 250.35 seconds and in diazepam group with prior i.v. access it was 119.4 seconds. i.m. midazolam acted faster in all age groups and in patients with febrile convulsions, which was statistically significant. i.m. midazolam was equally effective in various types of convulsions be it GTC or focal convulsions. 7 patients (10.8%) had thrombophlebitis associated with i.v. diazepam administration whereas none of the patients in the midazolam group had any side effects, which was statistically significant. CONCLUSION: i.m. midazolam is an effective agent for controlling acute convulsions in children especially in children with febrile convulsions. It has relatively no side effects as compared to Intravenous diazepam and can be used as a first line agent for treatment of acute convulsions in patients with difficult intravenous access.

Case report: Diazepam in severe tetanus treatment.

The causes of death in tetanus are muscle spasms and spasm of the larynx, which are caused by blocking the release of inhibitory neurotransmitters in the spinal synapses, causing the uncontrolled spread of impulses. Diazepam controls the spasms by blocking the polysynaptic reflexes, working peripherally, without depressing the cortical center and has no cardiovascular or endocrine effects. High dose diazepam had been used and proved to be a good muscle relaxant. Diazepam seems to work better with tetanus than pancuronium bromide, but both drugs need mechanical ventilation. In cases where the dose exceeds 240 mg per day in a child, a ventilator should be on hand, and if the dose required is more than 480 mg per day, other drugs should be considered. In three cases of severe tetanus presented here, the first two were managed by diazepam and pancuronium bromide and the last case by high dose diazepam only. In the first case, the dose of diazepam was up to 480 mg/day. By using high dose diazepam in severe tetanus, management of the clinical manifestations of autonomic nerve involvement and the weaning process become easier. Most complications of severe tetanus became more manageable.

Intermittent diazepam and continuous phenobarbital to treat recurrence of febrile seizures: a systematic review with meta-analysis

Convulsions triggered by fever are the most common type of seizures in childhood, and 20 percent to 30 percent of them have recurrence. The prophylactic treatment is still controversial, so we performed a systematic review to find out the effectiveness of continuous phenobarbital and intermittent diazepam compared to placebo for febrile seizure recurrence. METHOD: Only randomized, double-blind, placebo-controlled trials were analyzed. The recurrence of febrile seizure was assessed for each drug. RESULTS: Ten eligible clinical trials were included. Febrile seizure recurrence was smaller in children treated with diazepam or phenobarbital than in placebo group. Prophylaxis with either phenobarbital or diazepam reduces recurrences of febrile seizures. The studies were clinical, methodological, and statistically heterogeneous. CONCLUSION: The effectiveness of phenobarbital and diazepam could not be demonstrated because clinical trials were heterogeneous, and the recommendation for treatment recurrence should rely upon the experience of the assistant physician yet

Serum diazepam levels after oral administration in children.

OBJECTIVE: To determine serum levels of diazepam after oral administration in children. PATIENTS AND METHOD: Forty six children admitted with febrile seizures were orally administered with 0.25 mg/kg/dose of diazepam six hourly for four doses. Trough (prior to the next dose) and peak (at 1 hour 20 minutes after the dose) serum levels of diazepam were analyzed. The patients were observed for adverse effects of the medication. RESULTS: The peak levels after 1st, 2nd, 3rd and 4th doses were above 0.15 microg/ml which is considered the therapeutic level in 93.5, 97.8, 97.7, and 100 per cent of the patients, respectively. The trough levels prior to the 2nd, 3nd, and 4th doses were greater than 0.15 microg/ml in 75.0, 84.0, and 91.3 per cent, respectively. Neither recurrent seizure nor serious adverse effects occurred in any of the patients. CONCLUSION: Serum concentrations above the therapeutic level were achieved after orally administered diazepam at 0.25 mg/kg/dose six hourly for four doses. Oral diazepam may be used as another method in the prevention of recurrent febrile seizures.